Dr. Shailesh Reddy

NPI1467814350

Summary

Provider Details

NPI Number 1467814350
Provider Name Shailesh Reddy
Credential
Specialization
Medical School Name Michigan State University College Of Human Medicine
Graduation Year 2016
Gender F
Entity Type Individual
PAC ID by PECOS 4688074776
Professional Enrollment ID I20210610002671
Enumeration Date 03/22/2016
Last Update Date 01/24/2022

Contact Details

Business Practice address 4705 SPICEWOOD SPRINGS RD, Austin,
78759-8402 Texas View on Google Map
Business Practice phone 512-920-0140
Business Practice fax
Mailing address 4240 AUTUMN RDG, Saginaw,
48603-8669 Michigan View on Google Map
Other phone
Other fax
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for Shailesh Reddy Update NPI

Payments

Total Payment Worth

$115.05
from 2 payments in the last 6 years

Total Cash or Cash Equivalent

$0.00
from 0 payments in the last 6 years

Total In-kind Items & Services

$115.05
from 2 payments in the last 6 years

Hospital Affilitation

Practices in Austin

Austin, Texas

Education & Training

Michigan State University College Of Human Medicine

2016

Group Affiliation

Organization Name PECOS PAC ID Members
Yessar Hussain Md Pa 2769706977 3
Newsletter for Healthcare Professionals

Provider Taxonomy Details

Provider Taxonomy 1
Grouping name
Taxonomy
License No.
R300765115741 (Michigan)
Primary Taxonomy
Taxonomy
License No.
T0901 (Texas)

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1467814350
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor Y
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Reddy
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name Shailesh
The first name of the provider, if the provider is an individual.
Provider Credential Text MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 4240 AUTUMN RDG
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Saginaw
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Michigan
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 48603-8669
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider First Line Business Practice Location Address 4705 SPICEWOOD SPRINGS RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name Austin
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Texas
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 78759-8402
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 512-920-0140
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date 03/22/2016
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 01/24/2022
The date that a record was last updated or changed.
Provider Gender Code F
The code designating the provider's gender if the provider is a person.
Provider Gender Female
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 390200000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Healthcare Provider Taxonomy #1
Provider License Number 1 R300765115741
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 MI
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code #2 2081N0008X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 2 A physician who specializes in neuromuscular medicine possesses specialized knowledge in the science, clinical evaluation and management of these disorders. This encompasses the knowledge of the pathology, diagnosis and treatment of these disorders at a level that is significantly beyond the training and knowledge expected of a general neurologist, child neurologist or physiatrist.
Healthcare Provider Taxonomy #2
Provider License Number 2 T0901
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2 TX
Provider License Number State Code #2
Healthcare Provider Primary Taxonomy Switch 2 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.